Provider Demographics
NPI:1790381127
Name:SCHAEFFER, JOYCE B
Entity Type:Individual
Prefix:
First Name:JOYCE
Middle Name:B
Last Name:SCHAEFFER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1160 SE PURITAN LN
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34983-3226
Mailing Address - Country:US
Mailing Address - Phone:177-282-8711
Mailing Address - Fax:
Practice Address - Street 1:1160 SE PURITAN LN
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34983-3226
Practice Address - Country:US
Practice Address - Phone:177-282-8711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-10
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL6906975311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home